Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure

BACKGROUND Deterioration of nutritional status during hospitalization in patients with chronic heart failure increases
mortality. Whether nutritional support during hospitalization reduces these risks, or on the contrary, may be harmful due
to an increase in salt and fluid intake, remains unclear.
OBJECTIVES The purpose of this trial was to study the effect of nutritional support on mortality in patients
hospitalized with chronic heart failure who are at nutritional risk.
METHODS A total of 645 patients with chronic heart failure (36% [n ¼ 234] with acute decompensation) participated in
the investigator-initiated, open-label EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and
Recovery of malnourished medical inpatients) trial. Patients were randomized to protocol-guided individualized
nutritional support to reach energy, protein, and micronutrient goals (intervention group) or standard hospital food
(control group). The primary endpoint was all-cause mortality at 30 days.
RESULTS Mortality over 180 days increased with higher severity of malnutrition (odds ratio per 1-point increase in
Nutritional Risk Screening 2002 score: 1.65; 95% confidence interval [CI]: 1.21 to 2.24; p ¼ 0.001). By 30 days, 27 of 321
intervention group patients (8.4%) died, compared with 48 of 324 (14.8%) control group patients (odds ratio: 0.44;
95% CI: 0.26 to 0.75; p ¼ 0.002). Patients at high nutritional risk showed the most benefit from nutritional support.
Mortality effects remained significant at 180-day follow-up. Intervention group patients also had a lower risk for major
cardiovascular events at 30 days (17.4% vs. 26.9%; odds ratio: 0.50; 95% CI: 0.34 to 0.75; p ¼ 0.001).
CONCLUSIONS Among hospitalized patients with chronic heart failure at high nutritional risk, individualized nutritional
support reduced the risk for mortality and major cardiovascular events compared with standard hospital food. These data
support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this
vulnerable patient population. (Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of
Undernourished Medical Inpatients Trial [EFFORT]; NCT02517476) (J Am Coll Cardiol 2021;77:2307–19) © 2021 by the
American College of Cardiology Foundation.